Entity Details

Basic

Entity Type:
Free Standing NF/SNF (Free Standing NF/SNF)

Medicaid #:
0808006

CCN #:
165294

Occupancy Type:
Beds

Max Occupancy:
46

Status:
Active

Close Date:

Accredited:
No Record Found

Accredited/Deemed:
No Record Found

License & Survey

License #:
780196

Initial License Date:

Current License Date:
08/01/2023

Renewal Cycle:
365

Entity Type Renewal Cycle(months):
12

Expiration Date:
07/31/2024

Months Since Last Survey:
2

Entity Type Survey Cycle(months):
12

Special Focus Facility:
No

Loss of NA Training Effective:

Loss of NA Training Expires:

Contact

Address:
610 East York Road

City:
Avoca

State:
Iowa

Zip:
51521-0728

Phone:
(712) 343-6398

Fax:

URL:

Administrator/License #:
Kristin Pauley / 105502

Administrator Email:
kpauley@careinitiatives.org

Files

Life Safety Code (LSC) Waiver:

Licensure Rule Variance: